Federal review certifies Medicaid payment system

ProviderOne certified as fully compliant by federal reviewers

Publish Date

07/20/2011

Author

CNSI

OLYMPIA – Federal reviewers from the Centers for Medicare and Medicaid Services have formally certified Washington State’s new Medicaid payment system as successfully implemented and fully operational, giving the state the green light to claim a higher federal-state match for funding system operations.ProviderOne, as the new Medicaid Management Information System is called, went live on May 9, 2010. Over the course of its first year of operation, it paid and processed more than $5.4 billion worth of medical and nursing home billings.

OLYMPIA – Federal reviewers from the Centers for Medicare and Medicaid Services have formally certified Washington State’s new Medicaid payment system as successfully implemented and fully operational, giving the state the green light to claim a higher federal-state match for funding system operations.ProviderOne, as the new Medicaid Management Information System is called, went live on May 9, 2010. Over the course of its first year of operation, it paid and processed more than $5.4 billion worth of medical and nursing home billings. Nearly a year and a half earlier, ProviderOne began paying pharmacy “point-of-sale” claims – a different billing system – on October 20, 2008.ProviderOne met its first medical/nursing home payment deadline three days after going live andhas not missed a payment deadline since. During its first year, it processed more than 35 millionclaims from doctors, dentists, hospitals, nursing homes and scores of other provider types.The new system is faster and more accurate than the 25-year-old legacy mainframe it replaced. The system is able to catch billing mistakes and fraudulent claims before payment is made, saving the state from chasing down and trying to recover overbillings afterwards.

ProviderOne also performs detailed adjudication of billings, automating many of the providers’ administrative tasks, and organizing a wealth of data that will provide much stronger decision support for tax-savinginitiatives and health care planning. The system also may have set a record for receiving certification without a single official finding, said Heidi Robbins Brown, Deputy Director of the Health Care Authority, who supervised theproject since its inception.”It’s not unusual for new Medicaid Management Information Systems to take years to hit theirstride and win federal approval. It’s also not unusual to backstop new systems by paying manyproviders on a lump sum basis, estimating their payments based claims histories, ” she said. “ButProviderOne never required that kind of adjustment. It was like the Energizer Bunny – just kept onrunning.”Certification means the state can claim enhanced federal match of 75-25 percent back to the operational dates of May 9, 2010, and October 20, 2008 – although that money has already been calculated in past and current Medicaid budgets.The federal certification also did not include any correctional findings – flaws that the state wouldhave needed to fix before the certification could be finalized.

Primary contractor on the new system is CNSI, a Maryland company which has been working with the Department on the project since 2005. The company has also worked on Medicaid payment systems in Maine and Michigan and was recently selected to replace that system in Louisiana.The new computer payer system’s budgeted cost of development at launch was $161 million, with most of the project’s supported by a 90-10 percent federal match. The federal government invests heavily in the Medicaid Management Information Systems because of the long-range efficiencies the upgraded computers can bring to the state-federal partnership. FOR MORE INFORMATION:Doug Porter, Director, Health Care Authority, 360-725-1040Heidi Robbins Brown, Deputy Director, Health Care Authority 360-725-1040John Anderson, ProviderOne Project Manager 360-725-1007